The government is expected to fall well short of its target of recovering £500m a year from overseas visitors treated in NHS hospitals in England.

The Department of Health has “refined” to £346m its target for 2017-18, says the National Audit Office. Some £289m was paid in 2015-16; £73m in 2012-13.

A new “surcharge” for non-EU patients accounts for much of the rise, but only about half of debts owed are recovered.

The Department of Health said the increase showed “very good progress”.

NHS Trusts in England are legally obliged to check whether patients are eligible for free non-emergency NHS treatment and to recover any costs from overseas patients.

People from the European Economic Area (EEA), and Switzerland, are usually covered by agreements such as the EHIC scheme – where their government is billed for their treatment – while those from outside the EEA are invoiced directly.

But the National Audit Office report estimated that only half of debts were recovered from patients from outside the EEA and found that only 58% of hospital doctors knew some people were chargeable for NHS healthcare at all.

That year, an extra £164m was raised from a new £200 a year surcharge on visa applications paid by temporary migrants from outside the EEA.

That year also saw a 53% increase on the amount NHS trusts in England charged directly to patients, mostly to visitors from outside the EEA – much of which is thought to be due to new rules that allow hospitals to charge up to 150% of the cost of treatment, rather than a case of more people being charged.

And although amounts charged to people visiting from countries within the EEA increased slightly, they remain “well below” the ambition to recover £200m a year by 2017-18. The latest forecast for EEA income for that period is £72m.

The report found some hospitals were better than others at recovering money – 10 NHS trusts in London accounted for half of the total amount charged to non-EEA patients in 2015-16. Twenty trusts said they had no patients using the EHIC scheme.

It praised the Department of Health for using IT systems to help trusts find patients who should be charged and for visiting 60 trusts to promote its “cost recovery programme”, and said new financial incentives for reporting and charging overseas visitors had had an effect.

But it estimated that “trusts recover around half of the amounts they charge directly to patients, mainly visitors from outside the EEA”, with recovery rates varying widely – and it was not really understood why.

Head of the National Audit Office, Amyas Morse said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.”

He said much of the increase in amounts charged and recovered over the past two years was due to changes to charging rules: “If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18.”

However, all providers of breast implant surgery will be expected to participate in the scheme.

Health Secretary Jeremy Hunt said: “We want the NHS to be the safest healthcare system in the world and anyone who chooses to have a cosmetic procedure has the right to safe care.

“The PIP breast implant scandal in 2010 affected thousands of people which is why we asked NHS Digital to develop a new register which will allow people to be traced swiftly if that is ever needed.”

As a result of poor record-keeping following the PIP scandal, many women were unable to find out if they had been given the faulty implants.

In some cases, because surgery providers had gone out of business, women who received the implants could not be traced.

The Breast and Cosmetic Implant Registry – which will be managed by NHS Digital – will include patients treated by both NHS and private providers.

And participation in the registry will be noted during Care Quality Commission (CQC) inspections.

The registry will be expanded in the future to also cover other cosmetic implants, such as buttock or calf implants.

It is expected to record more than 20,000 cases of implant surgery every year and allow complications with specific implants to be picked up.

Providers will be expected to submit data on patients via an online portal.

Explicit consent from patients will be required to add their details to the registry – and this is in addition to the usual consent for the surgical procedure.

Noel Gordon, chair of NHS Digital, said the registry marked a major step forward in improving patient safety for people who undergo breast implant surgery each year.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Association of Breast Surgery and the British Association of Aesthetic Plastic Surgeons welcomed the registry.

In a joint statement, they said: “This will protect patients by providing a way to actively monitor all implants, track and trace their use and provide data for further research, which may be used to further technological advances. We hope that all patients will consent to the submission of data on their behalf.”

The Driver and Vehicle Licensing Agency (DVLA) is not making fair decisions about medical fitness-to-drive cases, a report has suggested.

The Parliamentary and Health Service Ombudsman’s report found “major failings” in eight drivers’ cases. It said people’s lives had been put on hold for years because of flawed decision-making and poor communication.

The DVLA said the vast majority of cases it handles are dealt with swiftly and correctly.

Criticisms in the report are directed at the Drivers’ Medical Group – the part of the DVLA which considers whether drivers with a medical condition are safe to drive.

The DMG makes between 600,000 and 750,000 licensing decisions every year and around 10% of those are complex cases dealt with by medical experts.

The report looked at eight complaints in detail which were received by the ombudsman between 2014 and 2015.

These all concerned people with complex medical conditions who were unfairly prevented from driving, sometimes for several years, the ombudsman’s report said.

The report found “major failings”, including evidence of flawed decisions, significant delays, poor communication and complaint handling in those cases.

And it said it was concerned that other people had also been treated unfairly and that the same mistakes could be repeated.

The report recommends that the DVLA improves the way it communicates with people applying for a licence and with medical professionals, and sets up robust standards to assess people with medical conditions fairly.

In addition, it says financial compensation should be offered to those affected by failures, where appropriate.

Parliamentary and Health Service Ombudsman Julie Mellor said the DVLA’s failings had had a real impact.

“People’s lives have been put on hold for years because of severe delays and flawed decisions by the DVLA, leading people to lose their jobs, causing stress, worry and isolation.”

She said the DVLA had produced a new guide for medical professionals and improved its complaint handling and communications – but there was still more to do.

“Further action is needed to make the assessments of fitness to drive more robust, to prevent others from suffering the same injustice in the future.”
Improvements